Healthcare Provider Details

I. General information

NPI: 1982949384
Provider Name (Legal Business Name): CHRISHINA SCOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4196 MAY APPLE LN STE 327
ATLANTA GA
30349-8223
US

IV. Provider business mailing address

7421 DOUGLAS BLVD SUITE 327
DOUGLASVILLE GA
30135-1564
US

V. Phone/Fax

Practice location:
  • Phone: 404-793-4627
  • Fax:
Mailing address:
  • Phone: 404-981-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007682
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: